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Page S <br /> PCmitac.CAFFESE,EUGgM Pwmit Number; 39-04-3900062 <br /> i" Deerip dm of Condtttons on fids Pew <br /> Cendhlen ID Deserlsdon <br /> A Permit Con&Table of Contests <br /> A-PERMIT CONDMON3-TABLE OF CONTENTS <br /> WOP33M SAFET"!C BERMS AT'rACRE D <br /> `, [ ]A-1 throughA 11 General Information <br /> PERMIT CONDITONS ATTACfiEd <br /> [3i:] P-General <br /> ( Q-Dicarnba dt Ply Herbicides-Central VelleyMazardous Am <br /> R- Dicamba&Phenoxyg-Special Hazardous Area <br /> ( j 8- Metam Sodium&Metsm Potassium <br /> [ j T- Aldicarb(Temik) <br /> [ j U- Fndosulfan(Thiodan) <br /> [ j V- Rice Pesticides Program <br /> [ ]-Molimft(Ordnm)Worker Safety(A) <br /> [ ]-Attachments 1-10: Molinate(1,6),7YAobencarb(2,5,7), <br /> �.. Metlrylpw*hion(3,9),Seepage Control(5), <br /> Propanil(10)and Malathion(voluntary:4,S). <br /> [ ]W-Methyl Bromide <br /> [ j-Soil within greenhouses <br /> �• [ ] <br /> -commodity <br /> [ ]-Soil injection <br /> [ ]-Terped potting soil <br /> [ ]-single tree site <br /> [ J X-Furadan chemigation of gapes <br /> [ j Y- 1,3-Dichloropropene <br /> [ ]Z-Other <br /> L <br /> PESTICIDE BAIZS: GROUNDWATER PROTECTION <br /> L [ ]The material I ase►posing will not be used in a Pesticide Management Zone(as described in Section 6802, <br /> Tide 3,California Code of Regulations)for agricultural,outdoor institutional or outdoor industrial use. <br /> [ ]The material I am purchaing will be used in a Pesticide Management Zone(as described in Section 6802.Title 3. <br /> California Code of Re&Wations)for agricultural,outdoor institutional or outdoor industrial use and a copy of my <br /> restricted materials permit is attached <br /> L Material purchased; ( ] Atrazine [ ] Simazine [ ] Brornacil <br /> [ j Diuron [ j Prometon [ j Bentazon <br /> �. I certify under penalty of perjury that the foregoing statement is true,and that I will not apply any material listed in <br /> Section 6800(x)in wry Pesticide Mm agement Zone for agriculture.outdoor institutional or outdoor industrial uses <br /> except in accordance with a permit issued by the county agricultural commissioner or the director in a county in <br /> which there is no carmnissioner. <br /> v <br /> Purchaser <br /> s� <br />